Intro­duc­tion

For an intro­duc­tion to PrEP, how it works as well as its pros and cons, we refer you to our PrEP FAQs. You will find inform­a­tion there to help you decide whether PrEP is right for you. You can also find out how a con­tinu­ous or peri­odic (inter­mit­tent) dosing sched­ule works.

This PrEPnu pro­to­col is based on the offi­cial Dutch PrEP guideline adopted by the Dutch Asso­ci­ation of HIV-treat­ing Phys­i­cians (NVHB) and the Phys­i­cians’ Expert Group for STI, HIV, sexu­al­ity and among other organ­isa­tions. It is advis­able to follow this (broader) guideline, ideally with the assist­ance of your doctor. There­fore, we recom­mend you to print out the offi­cial Dutch PrEP guideline, bring it with you to your doctor and open to the table on page 12. This table sum­mar­ises how you can use PrEP safely and which tests are required before you can start taking PrEP.

NOTE: PrEP is an extremely effect­ive measure for pre­vent­ing HIV. This has been sci­en­tific­ally proven. However, using PrEP is NOT a 100% guar­an­tee for pro­tec­tion (this applies to all pre­vent­ive meas­ures, includ­ing condoms).

 

Required medical testing for PrEP users

(Under­lined items are crucial for pre­vent­ing major health risks; other items are less import­ant but we still strongly recom­mend them.)

 

Before start­ing PrEP:

Kidney func­tion test + urine dip­stick test for protein and glucose levels in urine

 ‣ PrEP is not suit­able for people with impaired kidney func­tion. This must be ruled out by doing a kidney func­tion test before you start taking PrEP. You can request this test from your doctor, we also expect that the Public Health Service of Ams­ter­dam (GGD) will offer this test for free soon. The test determ­ines the cre­at­in­ine level in your blood; your doctor can also perform a test on the protein and glucose levels in your urine. These tests are inex­pens­ive and will not have a major impact on your health insur­ance deduct­ible excess.

Hep­at­itis B virus test

 ‣ This test is to rule out an active Hep­at­itis B infec­tion. It’s still import­ant to have your doctor perform this test even if you are com­pletely vac­cin­ated for Hep­at­itis B. The vac­cin­a­tion is not com­pletely effect­ive and there is a risk of becom­ing ill if you unknow­ingly have Hep­at­itis B and start taking PrEP.

     ‣ The Hep­at­itis B test is not required if you can show anti­body test results from the past that prove you are actu­ally immun­ised against Hep­at­itis B. Once you are immune to Hep­at­itis B, you will always be immune to it. Proof of vac­cin­a­tion alone is insuf­fi­cient.

HIV test (4th gen­er­a­tion HIV com­bin­a­tion test) + Screen­ing for other STIs: Chlamydia, Gonor­rhoea, Syph­ilis in the throat, anus and urine

 ‣ It’s extremely import­ant that you do not have HIV when you start taking PrEP because oth­er­wise the HIV virus can develop res­ist­ance to the active ingredi­ents in PrEP. That’s why you must be tested for HIV by your doctor or the Public Health Service (GGD), no longer than two weeks before you start taking PrEP. This has to be a 4th gen­er­a­tion HIV test. It takes at least a few days for you to receive the results. If you are tested by your doctor or the GGD (g. via mantotman.nl), then you will auto­mat­ic­ally receive this new type of HIV test. An HIV rapid test, which is usually done using a finger prick with results being provided imme­di­ately, is not suf­fi­cient.

Be tested for STIs every 3 months

 ‣ We strongly recom­mend you to get tested for STIs, includ­ing HIV and Hep­at­itis C, before start­ing PrEP and once every 3 months after­wards. Hep­at­itis C was found rel­at­ively often among people who signed up for the AMPrEP study. That’s why we advise you to be tested by your doctor using a Hep­at­itis C anti­body test.

 ‣ Note: HIV and STI tests per­formed by your doctor may not be reim­bursed by your health insurer. To avoid heavy costs, you can be tested for HIV and STIs by the GGD or by the Testlab of Man tot Man and then let your doctor conduct the other tests. The GGD does not auto­mat­ic­ally test for Hep­at­itis B and C.

Check for inter­ac­tions with med­ic­a­tions you already use

 ‣ PrEP inter­acts with some other med­ic­a­tions (for example, with Valaciclovir, a herpes med­ic­a­tion). If you are cur­rently using other med­ic­a­tions, it’s import­ant to check first to see whether these will inter­act with PrEP before you start taking PrEP.

 ‣ You can check with your doctor or phar­macists on hivdruginteractions.org. Fill in ‘Teno­fo­vir-DF’ and ‘Emtri­cit­abine (FTC)’ at the HIV Drugs section, then enter the med­ic­a­tions you’re cur­rently using (the active ingredi­ent, not the brand name; see the insert that comes with your med­ic­a­tions) under ‘Co-med­ic­a­tions’. The website will then indic­ate whether or not these med­ic­a­tions will inter­act with PrEP.

 ‣ If you have to start taking new med­ic­a­tions after you’ve started taking PrEP, then check again with your doctor or phar­macists to make sure no inter­ac­tions will occur, also be sure to inform your doctor that you are using PrEP.

 

1 month after start­ing PrEP:

Kidney func­tion test

 ‣ In rare cases, PrEP causes impaired kidney func­tion. That’s why it’s import­ant to test your kidney func­tion once again 1 month after you start taking PrEP.

HIV com­bin­a­tion test (4th gen­er­a­tion ELISA); see above

 

Every 3 months after start­ing PrEP:

HIV com­bin­a­tion test (4th gen­er­a­tion ELISA); see above
STI screen­ing: Chlamydia, Gonor­rhoea, Syph­ilis in the throat, anus and urine

 

Every 6 months after start­ing PrEP:

Kidney func­tion test
✯ Hep­at­itis C virus test